One particular question some parents have: What are the possible effects of anesthesia on a child’s learning ability?

Importance of limiting exposure

In late 2016, the Food and Drug Administration (FDA) released a warning that “repeated or lengthy use” of general anesthetic or sedation drugs during surgeries or procedures in children younger than 3 years of age may affect development of children’s brains.

The FDA defined “lengthy” as greater than three hours of exposure.

Dr. Niezgoda says, “I suggest that parents consider delaying elective procedures in younger children until they are at least 3 years of age, especially if the procedure will take longer than three hours to perform.”

It’s an easier decision to make if the procedure can be delayed without introducing any additional risks.

“For example, if a child born with an extra finger or toe, which is a relatively simple procedure to repair at any time, it makes sense to consider delaying until the child is at least 3 years of age,” Dr. Niezgoda says.

On the other hand, sometimes surgery (and the anesthesia that goes along with it) are necessary for younger children.

If their condition or problem calls for prompt and urgent action (and if delaying surgery could negatively affect their health and/or development) it’s important these children get the treatment they need.

She says it’s always important to talk to your child’s doctor to understand the benefits and risks of the surgery.

Human studies ease concerns

Fortunately, if exposure is limited and used in children who are older, several studies support their safety.

Research of children who have had only one exposure to anesthesia suggest that “anesthesia is very safe and that children’s long-term cognitive development is unaffected,” says Dr. Niezgoda.

One large study of 2,500 ninth graders found no significant difference in educational outcomes between students exposed to a single anesthetic for hernia repair and age-matched students never exposed to an anesthetic.

Another study compared twins having a single anesthetic to twins never exposed to an anesthetic and found no relationship between anesthesia and cognitive performance (learning ability). While these studies are encouraging with regard to the safety of anesthesia in children the data was retrospective (looking at children who already had anesthesia).

Currently, several ongoing studies are underway to assess the long-term impact of single and multiple exposures to anesthesia on the cognitive development of children.

“It will take some time to interpret the data because researchers are studying higher learning ability over multiple years of multiple evaluations,” Dr. Niezgoda says.

A caveat about timing

“Based on the available data, it would be inappropriate to deny or delay surgery that a child needs for fear of unknown consequences,” says Dr. Niezgoda.

“But if surgery is not essential during the first three years of life, then parents may consider delaying it until later.”

If you have any concerns about the timing of your child’s procedure, talk them over with your surgeon.

Minimal exposure + comfort

During surgery, pediatric anesthesiologists use the smallest amount of anesthesia that can effectively control the sedation and pain related to the procedure. Everything is weight based.

“We often use techniques to block pain only in the area of surgery,” says Dr. Niezgoda. “This exposes the child to less anesthesia overall.”

Yes, it’s important to minimize children’s exposure to anesthesia — but it’s critical to control their pain. Otherwise, children can experience early and long-term problems from the “stress response” to surgery.

This is because surgery not only affects tissue at the site of the operation. “It also causes an increase in hormones and chemicals throughout the body,” says Dr. Niezgoda.

“These chemical changes are called the stress response, and they can have significant effects on recovery. After surgery, a child’s heart rate, blood pressure, pain scores and inflammatory/immune system can undergo change as a result of the stress response.”

Tips for parents about children’s anesthesia

Anesthesia is geared to a child’s age and developmental stage. Dr. Niezgoda advises parents to discuss their child’s needs with the anesthesia provider before surgery.

A few simple examples:

Mention thumb-sucking. If your toddler sucks his or her thumb, the anesthesiologist can often place the IV in the foot instead of the hand to provide comfort — and remove one source of irritation.

Address fear of needles. Most kids who are afraid of needles can fall asleep under a mask before the IV is inserted (unless they have a medical condition that won’t allow it, such as gastric reflux, or airway or stomach problems). For older children, an anesthetic cream will be applied to numb the hand first.

Reassure kids about pain control. “Encourage all children to ask questions about anything they are concerned about — pain control or other issues,” Dr. Niezgoda says. Teens may worry about waking up during surgery. Tell them that anesthesiologists will constantly monitor them to ensure that they stay asleep and that they have minimal pain when they wake. Let kids and teens know the healthcare team welcomes any questions — at any time.

Before surgery, ask your child’s care team, including the surgeon and anesthesiologist, any questions you have. They want to support you and will address any concerns.